Quality-Focused Care Misses The Mark

When a physician winds up in the emergency department, providers put quality metrics and testing before her actual needs.

It was just after 6 o’clock in the evening on Wednesday, December 7, 2011—Pearl Harbor Day—when I left my organization’s Washington, D.C., office to meet a colleague for dinner. It was dark and rainy, and I had one more intersection to cross to get to the restaurant. I was about a third of the way across the intersection when I heard a loud “thump” and felt a sharp pain squarely in my backside. A dialogue unfolded in my head: “Wow! I wonder what that was…. I think it was me. No, I don’t think it was me. Wait…I think I just got hit by a car! But there’s no way!” Before I could even make sense of the situation, I had flown through the air and landed on the street.

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I was struck by the uneven nature of my care, marked by an overreliance on testing and a narrow focus on limited quality metrics such as pain management or catheter care processes. Looking back, I believe that this approach fostered an inattention to my overall well-being. Instead of feeling like a connected patient at the center of care, I felt processed and disengaged. This is disconcerting, especially at a time when patient-centered care—that is, care delivered with me, not to me or for me—is becoming the new normal.